Provider Demographics
NPI:1902805609
Name:SAKAMOTO, ROSARIO ODENA (NP)
Entity type:Individual
Prefix:MRS
First Name:ROSARIO
Middle Name:ODENA
Last Name:SAKAMOTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21402 AMBUSHERS ST
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3803
Mailing Address - Country:US
Mailing Address - Phone:909-861-2987
Mailing Address - Fax:
Practice Address - Street 1:1201 S HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-2200
Practice Address - Country:US
Practice Address - Phone:626-968-0547
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 8894363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ33925ZMedicaid
CAZZZ33925ZMedicaid